Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2018
Review[Difficult Airway Management in Thoracic Anaesthesia].
Difficult airway management in thoracic anesthesia has rarely been addressed in current guidelines. However, difficult airway management may be a challenge in thoracic anaesthesia: Achieving lung separation and collapse in combination of potentially distorted upper airway anatomy (difficult upper airway), the presence of subglottic pathologies (difficult lower airway) and the need for one-lung ventilation (difficult lung separation). This review will focus on identification of patients at risk, recommendations and algorithms for the airway management in the anticipated and unexpected difficult in-/extubation, and choice of devices for lung separation in this context.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2018
Review[Use of Bronchial Blockers for Lung Isolation].
Traditionally the double-lumen-tube (DLT) is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker (BB) to establish one-lung ventilation. Children under 8 years of age and patients without a patent orotracheal airway necessitate the use of a bronchial blocker in most cases, as well as those requiring selective lobar blockade or a rapid sequence induction. ⋯ Placement times for lung isolation devices and surgical exposure may depend more on the experience of the anaesthetist than the device itself. Bronchial blockers won't replace the DLT as gold standard at least due to their cost of acquisition, but provided adequate training outside of the emergency situation, their utilisation offers equal operative conditions at comparable placement times, dislocation rates and ease of use. A modern bronchial blocker should be available in institutions managing complex thoracic cases.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2018
Review[Airway Management in Thoracic Anesthesia with Double-Lumen Tube].
Lung separation and isolation with accomplished one-lung ventilation plays a key role in the airway management for thoracic surgery. Spectrum of indication contains thoracic surgery, procedure- and patient-dependent factors. ⋯ Knowledge in tracheobronchial anatomy is routinely requested for anesthesiologists just as the standard use of flexible fibreoptic bronchoscope. This review would give an overview and discussion about the airway management in patients during thoracic anesthesia with double-lumen tubes and recommendations for the clinical routine.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2018
Review[Anastomotic Leakage in the Gastrointestinal Tract: Surgical Versus Nonoperative Management].
Most procedures in gastrointestinal (GI) surgery require reconstruction with an anastomosis. Depending on the location within the GI tract, the perfusion and comorbidities of the patients there is a risk for anastomotic leakage. In case of peritonitis with sepsis usually a surgical treatment is required. ⋯ In case of a leakage of an esophagojejunal or esophagogastric anastomosis after resection of the esophagus or stomach endoscopic treatment can be successful using either clip or stent or negative pressure therapy (NPT). After surgery of the rectum the use of endoluminal NPT has shown good results in case of anastomotic leakage. Nonoperative management of anastomotic leakage can be successful in a stable patient and requires intensive cooperation in an interdisciplinary team with experts in surgery, endoscopy, radiology and intensive care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2018
Case Reports[Unusual Case of a a Severely Injured Toddler - Pre- and Early Hospital Treatment and Happy End Despite Obstacles].
A 16-month-old boy suffers a massive trauma (open dislocated pelvic fracture and decollement with haemorrhagic shock) due to a traffic accident. We present the characteristics and obstacles in the prehospital and early hospital emergency care of this severe and rare trauma in a pediatric patient with an emphasis on medical-operational tactics.